Cardiac Patients Research Articles

CMR-derived pulmonary artery to aorta ratio as a predictor of adverse outcome in patients with cardiac transthyretin amyloidosis

Abstract Introduction Cardiac transthyretin amyloidosis (ATTR) represents a heart failure phenotype often accompanied by pulmonary hypertension. The pulmonary artery to aorta ratio (PA/Ao), as assessed on cardiac computed tomography or cardiac magnetic resonance (CMR), has demonstrated to indicate risk for adverse events in a variety of cardiovascular diseases, particularly in heart failure and pulmonary hypertension. However, its prognostic value in cardiac ATTR remains unknown. Aim We aimed to investigate the prognostic value of the PA/Ao ratio in patients with cardiac ATTR. Methods Data of consecutive patients diagnosed with cardiac ATTR undergoing CMR were prospectively collected. PA/Ao ratios were measured from CMRs using axial images (Figure 1A). Adverse outcome, defined as heart failure related hospitalizations and/or mortality, was recorded during follow-up. Results Among the 190 confirmed cardiac ATTR patients (mean age 76±11 years, 79% males), encompassing hereditary transthyretin (vATTR, n=22) and senile (wtATTR, n=168) types, the median pulmonary artery diameter was 28mm (IQR 25-31) and the median ascending aorta diameter was 35mm (IQR 33-39). Over the median follow-up period of 28 months (IQR 11-50 months), 84 (44%) patients experienced an adverse event. Kaplan Meier curves demonstrated an increased risk for adverse outcome in patients with PA/Ao ratios above the median of ≥0.8 (p<0.001 by log rank test, see Figure 1B). In univariate analysis, a high PA/Ao ratio was associated with adverse outcome (HR=10.3, 95% CI=2.59–41.1, p<0.001). When adjusted for age, sex, body mass index and right ventricular function, the PA/Ao ratio remained significantly related to adverse outcome (adj. HR=10.8, 95% CI=1.76–65.8, p=0.010). Conclusion A PA/Ao ratio ≥0.8 on CMR is associated with heart failure hospitalization and death in patients with cardiac ATTR. This threshold, notably lower than the commonly reported ≥1.0 in other patient populations, holds promise for future risk stratification.

Mild hypercapnia versus normocapnia in resuscitated out-of-hospital cardiac arrest patients: a systematic review and meta-analysis

Abstract Introduction After out-of-hospital cardiac arrest (OHCA) resuscitation, current guidelines recommend normocapnia. However, mild hypercapnia may confer several physiological benefits that could enhance post-OHCA outcomes. purpose To assess the effects of moderate hypercapnia versus normocapnia on clinical outcomes after OHCA resuscitation. Methods A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) and observational studies were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through August 15th, 2023. Dichotomous outcomes were pooled using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI). Results We included five studies with a total of 42,076 patients. There was no difference between both groups in all-cause mortality (RR: 1.15, 95% CI [0.89 to 1.49], p=0.29), good neurological recovery (RR: 0.95, 95% CI [0.81 to 1.12], p = 0.56), mechanical ventilation duration (MD: 1.00, 95% CI [-5.41 to7.41], p= 0.76), ICU length of stay (MD: 0.01, 95% CI [-0.28 to 0.30], p= 0.96), neuron-specific enolase level (MD: -20.92, 95% CI [-69.53 to 27.69], p= 0.40), and the incidence of any serious adverse events (RR: 1.55, 95% CI [0.06 to 42.92], p= 0.80). However, length of hospitalization was lower in the mild hypercapnia group (MD: 0.99, 95% CI [-1.85 to -0.14], p= 0.02). Conclusion Mild hypercapnia did not decrease all-cause mortality or improve neurological recovery after OHCA resuscitation compared to normocapnia. However, mild hypercapnia significantly reduced the length of hospital stay.Main outcome

Factors influencing hospital stay duration in an elective cardiac surgery cohort

Abstract Cardiac surgery has become more complex in recent years, with increases in patient age, complexity, and associated costs. The use of a multidisciplinary strategy to analyze and standardize patient management offers significant benefits. The development of Enhanced Recovery After Surgery (ERAS) programs has proven useful in various types of surgery, recently including cardiac surgery, yielding good results. One of the primary objectives of ERAS programs is the reduction of the Inpatients' length of stay (LOS), with the subsequent improvement in the patient experience and a reduction in costs. The aim of this study is to analyze preoperative and postoperative factors related to the LOS reduction in a cohort of elective cardiac surgery patients included in the Cardiac ERAS program at our hospital. All patients included in the ERAS program, corresponding to elective cardiac surgery, were included in the analysis. 138 patients were divided into four quartiles based on the inpatient’s LOS. An extensive search was conducted in our quality control database, which contains 470 variables on the factors more strongly associated with LOS. The results were analyzed using Chi-Square test for categorical and the Kruskal-Wallis test for continuous variables, generally of non-normal distribution. The results are summarized in the table. Age, poor mobility, surgery other than coronary bypass, and reoperation were the non-modifiable factors most associated with a prolonged LOS. Lower preoperative hemoglobin and albumin levels were associated with an increase in LOS. A class 3 or 4 NYHA functional class, chronic pulmonary disease, and anticoagulation use were associated with higher LOS. Classic cardiovascular risk factors, such as dyslipidemia, hypertension, and tobacco use, were not associated with differences in hospitalization duration. Postoperative and intraoperative factors associated with higher LOS included extubation in the operating room or within six hours, ICU stay duration, mobilization on postoperative days one and two, time to oral food tolerance and gut motility recovery, hyperglycemia on postoperative day one, the duration of arterial, venous, and urinary catheters, the amount of fluids on postoperative day one and the opioid use in POD 2. The complications most associated with a prolonged duration were any infectious complication, any respiratory complication, reoperation, readmission to intensive care, transfusion after 12 hours or at any time during hospitalization, prolonged postoperative sedation, and any rhythmic complication. Conclusion In our cohort of elective patients for cardiac surgery, factors traditionally addressed by ERAS programs were identified as being associated with a longer inpatient’s length of stay. Pre-operative nutritional and anemia optimization, early extubation and mobilization, and the prevention of respiratory and infectious complications should be targeted to improve hospital stay duration.

Acute kidney injury (AKI) in cardiac intensive care unit patients: a real challenge to overcome

Abstract Introduction Acute kidney injury (AKI) is a major cause of morbidity and mortality in intensive care units (ICUs), but in cardiac intensive care unit (CICU), despite the evidence of a causal link between cardiac illness and AKI, few data are available (1). Purpose We analyzed the predictive factors of AKI in CICU, as well as the impact of AKI on the long-term prognosis of patients admitted to CICU. Methods We reviewed the medical data of patients admitted to our CICU over a 2-year period. We excluded patients with chronic kidney disease prior to admission. We defined AKI according to the KDIGO (Kidney Disease Improving Global Outcomes) classification based on serum creatinine and urine output. To determine the predictive factors, we performed a logistic regression analysis, and to determine the prognostic impact of AKI, we performed a Cox proportional hazards regression, taking all-cause mortality at 30 months as the main study outcome. p-values less than 0.05 were considered statistically significant Results We included in our study 1581 patients hospitalized in our unit over a 2-year period, 70.4% of whom were men and 29.6% women. Among these patients, 291 presented with AKI (18.4%), 35.5% classified as KDIGO 1, 42% as KDIGO 2, and 22.5% as KDIGO 3. For the admission diagnosis of patients with AKI, STEMI came first at 56.3%, followed by NSTEMI at 17.3%, acute heart failure at 9.3%, pulmonary embolism at 2.1%, severe arrhythmias at 7.9%, and valvular disease at 1.1%. Among patients in the KDIGO 3 group, 54% benefited from a renal replacement strategy. La morta For factors predictive of AKI, and after adjustment for variables significant in univariate analysis, we objectified the following factors: arterial hypertension (OR=1.92, p<0.001), Diabetes (OR=1.50, p=0.007), KILLIP>2 at admission (OR=1.75, p=0.003), Ejection fraction<40% at admission (OR=1. 93, p<0.001), right ventricular systolic dysfunction (OR=2.95, p<0.001), anemia with Hb<10g/dl (OR=2.95, p<0.001), cardiogenic shock (OR=3.02, p<0.001), high-grade conduction disorder (OR=2.7, p=0.003) and bleeding events (OR=5.93, p<0.001) (Table 1-figure 1). For all-cause mortality at 30 months, 204 events were observed, 104 in the AKI group (35%), and 100 in the non-AKI group (7.75%) (p<0.001), and AKI was independently associated with the outcome studied for all KDIGO classes with for stage 1 (HR = 1.33; p=0.03), stage 2 (HR = 2.28; p<0. 001), and stage 3 (HR = 5.71; p<0.001), adding to this diabetes (HR = 1.96; p<0.001), cardiogenic shock (HR = 2.27; p<0.001) and finally EF<35% at discharge (HR = 1.53; p=0.001) (Table 2-figure 1). The Kaplein-Meier survival analysis showed a significant difference between the rates of mortality between the different KDIGO at 30-months, with a log-rank test p<0.001 (Figure 2). Conclusion We can conclude that AKI remains a real challenge for admitted patients, since long-term mortality in this group is very high.Figure 1.Figure 2.

Impact and determinants of depression in cardiac hospitalized patients

Abstract Depression increases cardiovascular risk and involves worse clinical outcomes. Little attention is paid to it in hospitalized patients. We studied prevalence and determinants of depression in this group, in order to select patients for further specific management. Methods Consecutive patients admitted to Cardiology wards were included. Cardiovascular risk factors, clinical and psychosocial data were collected. Self perceived mental and physical health quality were assesed by 12-item Short Form survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) questionnaires were administered. Statistical analysis was performed using Spearman´s correlation, Mann-Whitney and Fisher tests, and Mantel-Cox, linear and logistic regression analyses. Results 170 consecutive patients, median age 74.5 (67.2-81.1), 59.4% male, were included. Most common pathologies were heart failure (44.7%) and coronary syndroms (28.8%). According to HADS results, depression was probable (score >10) in 10%, and at least possible (score > 8) in 27.1%. Both increased duration of hospitalization (Median 14 vs 7 days;p=0.016 and 11 vs 7 days;p=0.005 respectively). Anxiety was present in 16.5 % for probable case and 34.1% for possible case, with no significant change in median duration of hospitalization. 22.9% of patients were under antidepressant treatment, and 24% under anxiolytics, but they were added to treatment only in 1% and 7% respectively. No other not pharmacological measure was initiated. Self perceived mental health was diminished in probable depression (mean difference 14.9%;95%IC 9.7-20.2;p<0.001). Self perceived physical health was also lower (mean difference 6.4%;95%CI:1.1-11.8;p=0.016). Patients with depression were a mean of 5.6 years older (95%CI 1.4-9.8;p=0.032). Less than primary education (OR 5.69 (p 0.021), and Previous hospital admission OR 3.2 (1.0-10.3;p=0.034) increased the risk of depression in univariate analysis. By multivariate analysis, determinants of depression were anxiety (OR 22.5;95%CI 5.9-85.6;p<0.0001), need for surgery (OR 12.3;95%IC 2.1-73.2;p=0.009), need for intensive care unit surveillance (OR 4.2;95%CI 1.1-15.8;p=0.039), and age (OR 1.1;95%IC 1.0-1.2;p=0.001. AUC was 0.89;95%CI 0.81-0.96;p<0.0001. There was no difference in civil status, gender, income level, living accompanied, number of comorbidities, cardiovascular risk factor or reason for hospital admission. Conclusions Depression was prevalent in our hospitalized cardiac patients,in spite of previous pharmacological treatment. It prolongs duration of stay and impacts negatively in self perceived mental and physical health. Risk is increased in older people requiring intensive care surveillance or surgery, and specially by anxiety. These patients could benefit from a preventive multifactorial approach. Attention should also be paid to patients with a previous hospitalization and low educational level.ROC curve for multivariate model

Human epicardial adipose tissue-derived factors promote atrial endothelial dysfunction: role of pro-inflammatory cytokines and AT1R/NADPH oxidases/SGLT2 pro-oxidant pathway

Abstract Introduction Epicardial adipose tissue (EAT) has been suggested to contribute to left atrium dysfunction via paracrine mechanisms to induce endothelial dysfunction, pro-arrhythmogenic and pro-remodeling responses thereby favoring atrial fibrillation (AF) onset. Recently, sodium-glucose co-transporter2 inhibitors (SGLT2i) have been shown to reduce AF incidence, EAT volume, differentiation and inflammation, however, the underlying mechanisms are unknown. Purpose This study investigates the impact of human EAT-derived mediators on atrial endothelial cell function and, if so, to characterize the role of SGLT2 using the inhibitor empagliflozin (EMPA). Methods Epicardial and subcutaneous adipose tissues (SAT) were collected from 70 cardiac patients at a university hospital. Conditioned medium (CM, 24 h) from fats were applied to porcine atrial endothelial cells (AECs, first passage) for 24 h. Histology of tissues was assessed by haematoxylin and eosin staining, protein expression by Western blot analysis or immunofluorescence staining, mRNA levels by RT-qPCR, formation of reactive oxygen species (ROS) and nitric oxide (NO) by fluorescent probes, and pro-inflammatory cytokine levels by ELISA. Results Compared to SAT, EATs were more vascularized with increased infiltration of M1-like macrophages, expression of proinflammatory cytokines (IL-1ß, IL-6, TNF-α), markers of ECs VCAM-1 and eNOS, fibrosis TGF-β, NADPH oxidases NOX-1 and SGLT1/2. These effects were associated with a pro-oxidant response that was inhibited by neutralizing Abs directed against IL-1ß or IL-6, and by inhibition of either NOS, NADPH oxidases, ACE, AT1R or SGLT2. Levels of SGLT2 and ROS in EATs were higher in AF compared to non-AF patients and progressively increasing with age. CM of EATs showed higher concentrations of IL-1ß, IL-6, TNF-α and MCP-1 than that of SAT. Exposure of AECs to CM of EATs increased the level of oxidative stress that was positively correlated to the level of pro-inflammatory cytokines, and reduced basal and bradykinin-induced NO formation that was prevented by EMPA. It also resulted in upregulation of p53 and SGLT2 expression, and nuclear translocation of NF-kB by CM of the top quartile inflamed EATs but not by the lowest quartile of EATs or SATs, prevented by EMPA. Conclusion The findings indicate that compared to SATs, the EATs showed higher in situ expression and release of pro-inflammatory cytokines that contributed to oxidative stress involving the AT1R/NADPH oxidases/SGLT2 pro-oxidant pathway. CMs of inflamed EATs induced AECs dysfunction, oxidative stress and activation of NF-kB involving pro-inflammatory cytokines and SGLT2. Thus, SGLT2i appear as an interesting strategy to decrease EAT inflammation and improve endothelial function contributing to prevent cardiac remodeling and fibrotic responses.

Predicting physical fitness levels from resting ECG data: a machine learning approach in cardiovascular assessment

Abstract Background Exercise Stress Testing (EST), an inexpensive noninvasive modality, is widely used for preliminary cardiovascular evaluation and ongoing monitoring of cardiac patients. The MET (Metabolic Equivalent of Task) score from EST, indicating physical fitness, is associated with overall mortality risk and is extremely helpful for preoperative evaluation. Artificial Intelligence (AI) advances, particularly Deep Learning (DL) for resting ECG analysis, have significantly improved cardiac diagnostic accuracy. Objectives This study explores AI's ability to predict MET scores from resting ECGs, aiming to streamline fitness assessments and detect early changes in fitness levels. Methods The current analysis encompasses 45,518 consecutive EST evaluations from 31,532 individual patients from 2017 to 2023. MET scores were automatically computed using an established formula, while interpretations by certified cardiologists provided a benchmark for the AI model. Poor fitness was defined as being within the lowest quartile of MET scores, adjusted for sex and age. A deep learning framework was developed to process a 10-second snippet of resting phase ECG in raw waveform, predicting the likelihood of diminished fitness and thus acting as a binary classifier. The efficacy of this Poor Fitness AI model (PF-AI model) was assessed through metrics such as the area under the receiver operating characteristic curve (AUROC), along with sensitivity, specificity, and accuracy rates. Results The average age of the study group was 55±10 years, predominantly male (68.8%, n = 31,337). Among them, 1,152 were identified as having poor fitness. Applying the model to the entire cohort through 5-fold cross-validation yielded a sensitivity of 78%, a specificity of 81%, and an AUROC of 0.87 in predicting poor fitness. Conclusions Leveraging merely 10 seconds of resting ECG data, the PF-AI model proves to be a robust tool in predicting poor fitness levels, comparable to the outcomes of comprehensive stress testing.

Optimism mitigated impacts of pre-operative depression and anxiety on post-operative distress in cardiac patients

ABSTRACT Both anxiety and depression are comorbid mortality risks in middle-aged and older patients with heart diseases. Open-heart surgery (OHS), a life-altering procedure, can induce psychological distress that impedes postoperative recovery. Extensive research has shown the health benefit of optimism, an indicator of hope—a Character Strength in positive psychology. It predicts low mortality in cardiovascular disease—the number one killer of all Americans. Few studies, however, have explored whether that optimism mitigates the negative impact of preoperative depression and anxiety on postoperative general psychological distress. This interdisciplinary clinical study evaluated a hypothetical model of these relationships prior to and 1 month following OHS in 311 U.S. patients using a three-wave survey. Structural equation modeling (SEM) was performed to predict post-OHS general psychological distress. Optimism was indicated by two subscales in the Life Orientation Test (LOT). Based on the definition, general psychological distress was indicated by low symptom levels of somatization, depression, and anxiety as measured by the SCL-90 subscales. The final solution demonstrated a good fit. Optimism alleviates the negative effects of preoperative depression and anxiety, as indicators of poor mental health, on postoperative distress. Both older age and female gender were positively and directly associated with higher levels of post-OHS symptoms. The finding supports the beneficial role of optimism in mitigating the damage of poor mental health in the postoperative outcome of cardiac patients. The desirable function of character strength hope suggests that health providers should be attentive to and enhance inner strength for reducing the distress of cardiac patients in the postoperative recovery month.

Microaxial Flow Pump Hemodynamic and Metabolic Effects in Infarct-Related Cardiogenic Shock

Mechanical circulatory support with a microaxial flow pump (MAFP) has been shown to improve survival in ST-elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on hemodynamic stability over time is crucial for optimizing patient treatment. To determine if an MAFP reduces the need for pharmacological circulatory support without compromising hemodynamics compared with standard care in STEMI-CS. This was a substudy of the Danish-German (DanGer) Shock trial, an international, multicenter, open-label randomized clinical trial. Patients from 14 heart centers across Denmark, Germany, and the UK were enrolled. Inclusion criteria for the trial were STEMI and systolic blood pressure less than 100 mm Hg or ongoing vasopressor treatment, left ventricular ejection fraction less than 45%, and arterial lactate level greater than 2.5 mmol/L. Of the enrolled patients, after exclusions from death in the catheterization laboratory or immediately on intensive care unit (ICU) admission, the remaining patients had serial recordings of hemodynamics, arterial lactate, and use of vasoactive drugs. Patients who were in comas after cardiac arrest and patients with mechanical complications or right ventricular failure were excluded. Data were analyzed from May to September 2024. MAFP and standard of care or standard of care alone. Hemodynamic status in terms of heart rate and blood pressure, metabolic status in terms of arterial lactate concentration, and vasoactive-inotropic score (VIS). The clinical events during the first 72 hours were as follows: death from all causes, escalation of mechanical circulatory support, and discharge alive from the ICU. From 355 enrolled patients, 324 (mean [IQR] age, 68 [58-75] years; 259 male [80%]) underwent ICU treatment (169 [52%] in the MAFP group, 155 [48%] in the standard-care group). Baseline characteristics were balanced. There was no difference in heart rate between groups, and mean arterial pressure was above the treatment target of 65 mm Hg in both groups but was achieved with a lower VIS in the MAFP group. No difference in arterial lactate level was found between groups at randomization, but on arrival to the ICU, the MAFP group had significantly lower arterial lactate levels compared with the standard-care group (mean difference, 1.3 mmol/L; 95% CI, 0.7-1.9 mmol/L), a difference that persisted throughout the first 24 hours of observation. The MAFP group achieved lactate normalization (<2 mmol/L) 12 hours (95% CI, 5-18 hours) before the standard-care group. Use of a MAFP reduces the use of vasopressors and inotropic medication while maintaining hemodynamic stability and achieving faster normalization of lactate level in patients with STEMI-CS. ClinicalTrials.gov Identifier: NCT01633502.

Experience of Continuous Ambulatory Peritoneal Dialysis In Remote Area of Southeast Bangladesh

Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds area. J Dhaka Med Coll. 2023; 32(1) : 24-31

Perioperative Mechanical Circulatory Support for Cardiac Assistance in Thoracic Surgery: A Scoping Review Protocol.

Over the past decades, the number of cardiac patients (e.g., with advanced heart failure or existing cardiovascular comorbidities that expose them to a heightened risk of acute cardiovascular decompensation) requiring noncardiac surgery is rising. For this patient population, potentially curative surgical treatments may be denied due to their prohibitive perioperative risk. Around 30% of patients undergoing general thoracic surgery experience cardiovascular complications of varying severity that may ultimately result in refractory heart failure and/or hemodynamic instability. In both these scenarios, perioperative implantation of temporary mechanical circulatory support (tMCS) may improve patient outcomes by both expanding preoperative surgical eligibility criteria and enabling safer management of unexpected periprocedural complications. This scoping review seeks to summarize the current existing evidence on the role of tMCS for cardiac assistance in thoracic surgery and provide a thorough overview. We will perform a scoping review adhering to the Joanna Briggs Institute (JBI) methodology and the extension for Scoping Reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist (PRISMA). We will carry out a comprehensive search of several online databases to identify studies on the perioperative implantation of tMCS in patients undergoing thoracic surgery to provide cardiac assistance either due to their heightened preoperative cardiac risk (pre-emptive tMCS) or for acute cardiac failure due to inherent surgical complications (bail-out tMCS). Standardized forms will be employed to perform data charting and extraction. Retrieved studies will be presented through a narrative synthesis following initial categorization, supplemented by descriptive statistical analyses of quantitative data if adequate inter-study homogeneity is observed and further complemented by figures and tables. The planned scoping review aims to assess the safety and feasibility of perioperative implantation of tMCS in patients undergoing thoracic surgery either to mitigate their heightened cardiovascular risk or as a rescue strategy in the event of life-threatening surgical complications. It will identify knowledge gaps, offer direction for future research, and improve clinical practices within the field.

The Interaction Effect of Age, Initial Rhythm, and Location on Outcomes After Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study.

Background: Out-of-hospital cardiac arrest (OHCA) is a critical global health challenge and a leading cause of mortality. This study investigates the combined effect of initial cardiac arrest rhythm, patient age, and location on the return of spontaneous circulation (ROSC) in OHCA patients. Methods: This retrospective study analyzed medical records from the National Emergency Medical Service (EMS) in Poland between January 2021 and June 2022. Data from 33,636 patients with OHCA who received cardiopulmonary resuscitation (CPR) at the scene were included. Results: Public incidents were associated with higher ROSC rates (54.10% vs. 31.53%, p < 0.001). Initial shockable rhythms (VF/pVT) significantly increased the odds of ROSC (OR = 3.74, 95% CI 3.39-4.13, p < 0.001). Obesity decreased the odds of ROSC in at-home cases (OR = 0.85, 95% CI 0.73-0.99, p = 0.036) but had no significant effect in public cases. The effect of age on ROSC outcomes varied significantly depending on the location. In patients younger than 60 years, better ROSC outcomes were observed in at-home cases, while for those older than 60 years, the odds of ROSC were higher in public locations. Each additional year of age decreased the odds of ROSC by 1.62% in at-home incidents (p < 0.001) and by 0.40% in public incidents (p = 0.009). Sex differences were significant in public locations, with women having higher odds of ROSC compared to men (OR = 0.57, 95% CI 0.37-0.87, p = 0.009 for VF/pVT). Conclusions: The interaction between the location of OHCA, initial cardiac rhythm, and patient age significantly impacts ROSC outcomes. Public locations show higher ROSC rates, especially in cases with shockable rhythms (VF/pVT). Age modifies ROSC outcomes, with younger patients benefiting more at home, and older patients showing better outcomes in public places.

Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study

Diffusion-weighted magnetic resonance imaging (DW-MRI) performed before target temperature management, within 6 h of return of spontaneous circulation (ROSC), is defined as ultra-early DW-MRI. In previous studies, high-signal intensity (HSI) on ultra-early DW-MRI can predict poor neurological outcomes (Cerebral Performance Category 3–5 at 6-months post-ROSC). We aimed to assess the optimal-timing for ultra-early DW-MRI to avoid false-negative outcomes post out-of-hospital cardiac arrest, considering cardiopulmonary resuscitation (CPR) factors. The primary outcomes were HSI in the cerebral cortex or deep gray matter on ultra-early DW-MRI. The impact of CPR factors and ROSC to DW-MRI scan-interval on HSI-presence was assessed. Of 206 included patients, 108 exhibited HSI-presence, exclusively associated with poor neurological outcomes. In multivariate regression analysis, ROSC to DW-MRI scan-interval (adjusted odds ratio [aOR], 1.509; 95% confidence interval (CI): 1.113–2.046; P = 0.008), low-flow time (aOR, 1.176; 95%CI: 1.121–1.233; P < 0.001), and non-shockable rhythm (aOR, 9.974; 95%CI: 3.363–29.578; P < 0.001) were independently associated with HSI-presence. ROSC to DW-MRI scan-interval cutoff of ≥ 2.2 h was particularly significant in low-flow time ≤ 21 min or shockable rhythm group. In conclusion, short low-flow time and shockable rhythm require a longer ROSC to DW-MRI scan-interval. Prolonged low-flow time and non-shockable rhythm reduce the need to consider scan-interval.

Positive psychological well-being and cardiovascular health.

Positive psychological well-being (PPWB) is increasingly recognized as a critical factor in cardiovascular health of both healthy individuals and those with cardiovascular diseases (CVD). This mini-review synthesizes the current state of knowledge on the relationship between PPWB and cardiovascular health, examining relevant studies on PPWB in both populations. The conceptualization of PPWB encompasses hedonic and eudaimonic facets, with constructs such as optimism, purpose in life, and vitality playing crucial roles. Studies among healthy individuals show a significant association between PPWB and improved cardiovascular health indicators, while research among cardiac patients highlights the importance of PPWB in predicting outcomes such as mortality and rehospitalization. Mechanistic pathways linking PPWB and cardiovascular health include biological processes, health behavior changes, and additional psychological resources that mitigate stress. Despite the growing evidence, questions remain unanswered, necessitating further research to understand these relationships and develop effective interventions. Promoting psychological well-being alongside physical health can enhance cardiovascular disease prevention and management, offering a comprehensive approach to improving patient outcomes and overall well-being.

Assessing the Impact of the Pandemic on Treatment Outcomes for Cardiac Arrest Patients Utilizing Mechanical CPR: A Nationwide Population-Based Observational Study in South Korea

Introduction: Cardiopulmonary resuscitation with mechanical devices (MCPR) was developed to provide high-quality cardiopulmonary resuscitation (CPR) for patients with cardiac arrest. However, the effect of this procedure on treatment outcomes remains controversial. Nevertheless, during the coronavirus disease-19 (COVID-19) pandemic, in-hospital MCPR gained attention, owing to its advantages such as saving medical staff and preventing infection. This study compared the treatment outcomes of in-hospital MCPR and manual CPR for out-of-hospital cardiac arrest (OHCA) patients during the COVID-19 pandemic. Materials and Methods: This retrospective nationwide population-based study was conducted in South Korea. Data were collected from the Out-of-Hospital Cardiac Arrest surveillance database managed by the Korea Disease Control and Prevention Agency. We included adult OHCA patients transported by emergency medical services from 2016 to 2021. The study compared outcomes during the COVID-19 pandemic years (2020–2021) with the preceding non-pandemic years (2018–2019). The primary outcome was survival to hospital discharge, and the secondary outcomes were good neurological outcome and sustained return of spontaneous circulation (ROSC). Results: The entire study included 72,050 patients with OHCA and, in the multivariable analyses, MCPR was associated with lower survival rates compared to manual CPR (AOR 0.63; 95% CI 0.51–0.77; p &lt; 0.001). Interestingly, during the COVID-19 pandemic, while MCPR use increased, the survival rate did not differ significantly between the MCPR and manual-CPR groups. Conclusion: Our study findings suggest that while MCPR may offer potential benefits, such as decreased infection risk for healthcare workers, it did not demonstrate superior outcomes compared to manual CPR in our study population.

Effect of ayurveda-based panchakarma and lifestyle modification on global longitudinal strain in cardiac disorder patients

Effect of ayurveda-based panchakarma and lifestyle modification on global longitudinal strain in cardiac disorder patients

Poor correlation of venous lactate with systemic oxygen saturation in the paediatric cardiac ICU: a pilot study.

Cardiac intensive care providers require a comprehensive understanding of cardiac output and oxygen delivery. The estimation of cardiac output in clinical practice often relies on thermodilution and the Fick principle. Central venous saturation and lactate levels are commonly used indicators for cardiac output assessment. However, the relationship between venous lactate levels and venous oxygen saturation in paediatric cardiac intensive care patients remains unclear. This is a single-centre retrospective pilot study aimed to investigate the correlation between venous lactate and venous oxygen saturation in paediatric patients. Data collected included venous saturation, heart rate, mean arterial blood pressure, arterial saturation by pulse oximetry, cerebral and renal near-infra-red spectroscopy values, and the presence of a functionally univentricular heart. Statistical analyses included Bayesian Pearson correlation and regression analyses. A total of 203 data points from 37 unique patients were included in the analysis. There was no significant correlation between serum lactate and venous saturation (correlation coefficient = -0.01; Bayes factor 10 = 0.06). Serum lactate also did not correlate with other haemodynamic metrics. Venous saturation showed correlations with arterial saturation and cerebral and renal near-infra-red spectroscopy. Regression analysis revealed that parallel circulation, arterial saturation, and cerebral near-infra-red spectroscopy were predictive of venous saturation. The following equation resulted from the regression analysis: 68.0 - (12.7 x parallel circulation) - (0.8 x arterial saturation) + (0.3 x cerebral near-infra-red spectroscopy). This model had a Bayes factor 10 of 0.03 and adjusted R-squared was 0.29. In paediatric cardiac intensive care patients, there is no significant correlation between venous lactate and venous saturation, suggesting that lactate may not be a reliable marker for assessing the adequacy of oxygen delivery in this population. Only a weak correlation could be identified once the venous saturation was 70% or lower. Additional research is needed to explore alternative markers for monitoring oxygen delivery in critically ill paediatric patients.

Preclinical thyroid hormone profile studies of an ayurvedic medicine Parthadyarishta after chronic administration to male Sprague-Dawley rats

Background: Parthadyarishta (PRTm) is an Ayurvedic preparation used as a traditional medicine to treat heart disease. This research was designed to study the thyroid hormone profile after chronic administration of this drug. Methods: Twenty healthy Sprague-Dawley male rats (90-110 g) were randomly divided into a control group and an experimental group. The experimental group was assigned to receive the drug at a dose of 40 ml/kg of body weight orally. After 28 days of treatment, blood samples were collected to carry out biochemical tests to determine the thyroid hormone safety profile. Serum circulating levels of total thyroxine (tT4), total triiodothyronine (tT3), free thyroxine (fT4), free triiodothyronine (fT3), thyroid stimulating hormone (TSH) were measured by Chemiluminescent Microparticle Immunoassay (CMIA) method. Results: This study showed statistically significant (p=0.008) [21.93%] decrease in tT3 level and statistically significant (p=0.047) [10.73%] increase in fT3 level in the rats. Also, statistically insignificant decrease in tT4 level and increase in fT4 level were observed. There is a [49.96 %] decrease in TSH level (p=0.371). The results suggested that Parthadyarishta have exerted an opposite effect on both the total and free form of T3 by increasing the free form (fT3) though causing decrease in the total form (tT3). Conclusions: As Parthadyarishta has significant impact on thyroid hormone levels so it is recommended to use it cautiously for chronic use specially in cardiac patients. Further studies are needed to determine the toxicological profile of Parthadyarishta and its effect on cardiovascular system through interference in thyroid function.

Randomized Controlled Trial of Ultrasound-Guided Parasternal Intercostal Nerve Block and Transversus Thoracis Muscle Plane Block for Postoperative Analgesia of Cardiac Surgical Patients

Randomized Controlled Trial of Ultrasound-Guided Parasternal Intercostal Nerve Block and Transversus Thoracis Muscle Plane Block for Postoperative Analgesia of Cardiac Surgical Patients

Hydrogel encapsulating gold nanoparticles for targeted delivery of nitroglycerin to reduce post-cardiac dysfunction inflammation by inhibiting the Wnt/β-catenin signaling pathway.

The discovery of nitric oxide's role in biological processes like platelet function, vasodilation, cell permeability, and inflammation has advanced our understanding of organic nitrate therapy's hemodynamic and nonhemodynamic effects. Short-term use of organic nitrates prevents left ventricular enlargement and infarct expansion. However, information on their long-term impact on LV remodeling in post-acute cardiac dysfunction patients is limited. In this study, we utilized an innovative active hydrogel with gelatin (Gel)/polyethylene glycol (PEG)/polylactic acid (PLA) encapsulating gold nanoparticles (AuNPs)-based drug delivery system for the sustained release of nitroglycerin (NTG). Gel/PEG/PLA/NTG/AuNPs hydrogel-based system is a non-transplant surgical method that can adhere to the surface of the heart and deliver the drug directly to the epicardium. Cardiac dysfunction was induced by ligating the left anterior descending coronary artery. Echocardiograms were used to study the pre- and post-operative hemodynamics. Hematoxylin and eosin (H&E) and Masson's trichrome stain (MTS) stainingrevealed that the acute myocardial infarction (AMI) rats' group had irregularly shaped fibers and a lack of transverse striations, whereas Gel/PEG/PLA/NTG/AuNPs hydrogel group showed significant improvement. Rats in the Gel/PEG/PLA hydrogel group demonstrated marked vasodilation, compared to the AMI group. Mechanistically, we determined that hydrogel disrupts the initiation of post-cardiac dysfunction via inhibiting Wnt/β-catenin transcriptional activation. Hence, the Gel/PEG/PLA/NTG/AuNPs hydrogel group effectively protected against ischemic injury and inflammation in AMI, demonstrating a novel method for treating acute cardiac dysfunction.